That's oh-be-GUY-n, not oh-be-GIN, as some (primarily people from Texas) would like to refer to my chosen profession. Although, working in this field can sometimes cause one to develop a penchant for gin...hmmm.

Saturday, January 30, 2010

New Sensation

In my previous job, I essentially functioned as a solo practitioner, so I could be fairly certain that (like it or not) I would deliver nearly all of my OB patients. Not that I didn't wish sometimes that a few of them would happen to deliver on one of the 4 days that I was freed from the hospital. In many ways, knowing all my patients from beginning to end was really wonderful. I knew who was stoic and who was, er, well....not stoic. I knew who was a worry-wart, who never had a single complaint, who had a birth plan, and who wanted an epidural when they hit the front door. I knew who was having complications, how far along (ball park) they were, and sometimes could even remember how dilated they were at their previous checks (should they arrive in triage thinking they were in labor).

The very best part, however, was the relationships I developed with the patients during the span of their pregnancies. We got to know one another, build trust, and when the time finally came for delivery, the rapport was usually strong enough for us to communicate well during the process, and to celebrate together when the delivery was complete. Sometimes this could actually be somewhat detrimental, as getting "emotionally attached" to patients can be a hindrance to good medical care, but mostly, while I cared for women on a personal level, I was still able to objectively direct their care. Of course, I didn't "click" with every single patient (that is impossible) but I did feel like a level of trust and mutual respect was able to be fostered with many.

Now, in a much larger practice where there can be anywhere from 60-80 patients due in a single month, it is much harder to develop the same rapport. There are times when I haven't even had a chance to *meet* a patient before attending her delivery. We try to have the patients see every physician at least once, but sometimes it just doesn't happen. This makes it much harder to develop trust in one another, during a very crucial time. So far I have overcome this by taking some time when admitting the patient to review all the records (sometimes helpful, sometimes not, depending on who was doing the documentation) and to discuss the plan of care with the patient and their family members. It is strange to deliver someone that you don't know well, and though I did experience this with some of OtherDoc's patients back in Whooville, it was not on the same scale.

Another adjustment I have had to make, and I think I may have mentioned this before, is adjusting to the "way of the group." Before, the medical decisions I made about patient care were mine alone, now I have 4 other physicians that have to be somewhat on board with a plan of care. Not to mention the way that they handle gestational diabetics and inductions is very different than to what I had become accustomed in the prior four years. Plus, when I order certain tests, sometimes another physician is the one that gets the results and then makes the decision on how to proceed. Scheduling inductions is also tricky, sometimes I can't schedule them for myself, and worry that I may tick someone off by scheduling someone on their call day.

Through all of this, I have noticed a strange new phenomenon. It isn't consistent, but I am starting to be able to "feel" who I am going to deliver. I know, it sounds completely bat shit crazy, but it is the strangest sensation. I just get this little gut feeling with certain patients that I am going to be the one that does their delivery. It matters not if I happen to personally like the patient or if the patient is one with whom there is not a strong connection. There is no basis in anything concrete, and it sounds so new-agey and non-scientific when I write it out like that, but, so far, each time I have "gotten that feeling" it has been correct. Verrrrry interesting. I will continue to observe as time goes on. Has anyone else, patient or physician, experienced anything like that before?

The really nice thing about getting my bearings and settling in to the new job is how well I am clicking overall with the patients and the nursing staff at the hospital. It is so great to hear the nurses tell me that they like the way I manage patients, or to have a patient tell me "You were my favorite, I hoped it would be you delivering my baby!" Very satisfying, indeed. Happy weekend, all!

9 comments:

I go to a practice that was solo, then 2, and is now solo with a midwife. Due to laws in Virginia, she's not able to deliver in the hospital yet but does see patients in office. Anyway, when I had my second child, I was pretty sure that one doctor would deliver my baby. In fact, I suspect that I made at least 2 runs at trying to go into labor only to stop as soon as I figured out the other doctor was on call. It was far from purposeful- I was SOOO ready to get that baby out but I suspect it's what happened.

I've only had the opportunity for 2 OBs to deliver my baby during one pregnancy but for that one, I was pretty sure who would do the delivery. In fact, I suspect I tried to go into labor at least once and maybe twice, only to suddenly stop as soon as I realized the other doctor was on call. It was far from purposeful but I do think that there is an odd sort of something that goes along with the whole conception, delivery thing.

Maybe that "Feeling" is a connection to a patient, and then they know when you are on call and somehow the patient controls her onset of labor to coincide with your call schedule. (After all, we still do not really understand what initiates labor, do we?)

It would be interesting to do a blinded trial where the patient does not know your call schedule and see if your "feeling" is still on target,

I am an ob/gyn in a 4 person call group and I have very similar feelings. I don't think you are bat shit at all! ha ha! LOL! Glad to find you in whooville! Come visit me on:www.sailingtrainingwheels.com~L

I have something just as weird as an ob/gyn. Whenever I have a strip that is questionable or just not ideal, I get a "feeling" about who needs to be sectioned and who can make it vaginally. I still use my medical knowledge to manage labor patients, but whenever I get a "feeling" about who to section and who to let continue laboring, I listen. 7 years post residency, I have yet to be wrong. Of course, sometimes I have to get the nurses to buy into my plan!

..."I will pass my life and practice my art"... Your not crazy, you are practicing the art of medicine. As an OB nurse I'd trust your instincts before your medical knowledge any day! Your medical knowledge guides you in how to manage the medical problem that your gut is leading you to.

I totally believe you can somehow know in advance. I know when I'm about to get pimped. One person will get asked a question, and I just know I'm going to get a follow up. Or someone goes off on a tangent, and I know I'm getting a question. I've started touching my eyebrow to signal everyone my feeling. It freaks them out. It freaks me out too. Weird how the body can know things that it shouldn't be able to!